Ligature and applicator therefor

ABSTRACT

A vessel ligature constituted by a tape applied around a vessel by means of a hemostat adapted to pass under the vessel, engage the tape, and draw the engaged tape back below the vessel, the tape ends being then passed through an elongated wire loop and drawn with the loop into a plastic sleeve, the sleeve being slidable over the wire loop and along the tape toward the vessel to tighten the bight of the tape around the vessel, and the bight being maintained in vessel-closing position by means of a hemostat clamped on the plastic sleeve and/or tape at a distance from the vessel; and the method including said steps.

United States Patent Flores 51 May 30, 1972 54] LIIGATURE AND APPLHCATOROTHER PUBLICATIONS THEREFOR Plaut et al., A modification of Campbell sNoose, in Surgery, [72] Inventor: Mary Alice Flores, New Orleans, La. 6;1 1,079- 1964- [73] Assignee: C. R. Bard, lnc., Glens Falls, NY. PrimaryExaminer-Channing L. Pace Filed: p 1970 Att0mey-W. Saxton Seward [21]Appl. No.: 26,488 ABSTRACT A vessel ligature constituted by a tapeapplied around a vessel by means of a hemostat adapted to pass under thevessel, en- [Si] (51 luff/734(6) g g the tape and draw the g g p backbelow the [5 1 i sel, the tape ends being then passed through anelongated wire [58] Fleld of Search ..l28/326, 327, 334, 346 loop anddrawn with the loop into a plastic Sleeve the Sleeve being slidable overthe wire loop and along the tape toward [56] References Cited the vesselto ti hten the bi ht of the ta e around the vessel,

2 g P and the bight being maintained in vessel-closing position byUNITED STATES PATENTS means of a hemostat clamped on the plastic sleeveand/or tape at a distance from the vessel; and the method including said671,337 4/1901 Gibson 128/326 stelm 3,043,308 7/1962 Seltzer 128/3463,476,1 14 1 1/1969 Shannon et a1. 128/346 5 Claims, 8 Drawing FiguresPatented May 30, 1972 FIG 2 Sheets-Sheet 1 IN VENTOR.

-MARY A. FLORES nowwx ATTORNEYS Patented May 30, 1972 3,665,926

2 Sheets-Sheer. 2

INVENTOR.

Y MARY A. FLORES WWW ATTORNEYS LIGATURE AND APPLICATOR THEREFOR Thereare many surgical procedures in which closure of a vessel (e.g., vein orartery) for short or long periods of time is indicated, to arrest theflow to or from other organs or to or from specified portions of thevessel which are to be treated or observed. Metal clamps or the like arenormally used to effect such closures, but metal clamps are heavy, hard,frequently in the way, and likely to damage the vessel or adjacenttissues.

It is an object of the present invention to provide a simple, light,non-metallic vessel closing element, and the means for applying it.

The device comprises three cooperating parts: an elongated wire loopwith handle, a short plastictube through which the wire loop may bepassed, and a suitable length of tape (e.g., braided umbilical tape) ofa size such that its end portions can be drawn, doubled, through thetube by means of the loop. The wire loop may be provided with two piecesof plastic tube for use in effecting two spaced ligations of the samevessel.

A practical'embodiment of the invention and illustration of its methodof use are shown in the accompanying drawings, wherein:

FIG. 1 represents an elevation of the entire device, on an enlargedscale, with tape inserted in the wire loop (only a small piece of thetape being shown) and with one piece of plastic tubing carried by theloop, the position of a second piece of tubing, when desired, beingindicated in broken lines;

FIGS. 2 to 8 are detail, somewhat diagrammatic views showing successivesteps in the practice of the method.

Referring to the drawings, the applicator is constituted by an elongatedwire loop 1, the ends of the wire being securely fixed in a suitablemetal or plastic handle 2. The wire may suitably have a diameter of0.014 inch and a convenient length for the applicator is approximately 6inches. The end 3 of the wire loop is preferably curved to provide anopening 4, the purpose of which will be evident. As shown, two pieces ofsoft and flexible plastic tubing 5,6 are threaded on the loop and theends of a ligature 7, such as umbilical tape, extend through the opening4, in the position which they assume at an early stage of the ligatingoperation, just before the tubing has been pushed over the doubled endsof the tape, as the first step toward tightening it around a vessel (Vin FIGS. 2 to 8).

The openness of the loop end results from making it smoothly curvedrather than bent and is designed to facilitate the insertion through theloop of strands of ligating material such as umbilical tape 7, when theapplicator is in use as described below.

Referring to FIGS. 2 to 8, a vessel to be tied off at one or more pointsis shown at V. The vessel is freed sufficiently (e.g., by an arterialcut-down) to permit introduction beneath it of the end of a hemostat 8or similar instrument (FIG. 2) which grips an end of the ligature (tape)7 so that it may be drawn under the vessel. The ends of the tape arebrought together (FIG. 3), held by the hemostat, and passed through theopening 4 in the wire loop (FIG. 4) where they remain as the hemostat isremoved (FIG. 5). The piece of plastic tubing 5 is moved down past theend of the wire loop (FIG. 6) which draws the tape through the tubing,this movement being continued until the ends of the tape are free andcan be disengaged from the wire loop (FIG. 7). The clamping of thevessel can then be effected by sliding the tubing along the tape untilthe small bight 9 in the latter is tightened around the vessel (alsoFIG. 7), the tubing then being held in position by clamping the tapeand/or tubing at a point spaced from the vessel.

The sizes of the tape and of the tubing are coordinated to provide aloose engagement between them since the hemostat serves to hold them invessel closing position. A tighter fit can be effected if the free endsof the tape are long enough to remain in the tubing when the vessel isclosed, the wire loop being detached by cutting the tape, but this wouldtend to make removal more difiicult.

In FIG. 8 is shown the closing of the vessel at two spaced points, asfrequently required, the second closure being effected by the use of asecond tape 7' applied and secured as described above, using the secondpiece of tubing 6 and clampin it in place by means of a second hemostat8.

To re ease the tie-offs, the hemostats (or the like) are removed, thetubing is retracted and the tape may be cut on one side or the other ofthe vessel permitting the end beneath the vessel to be withdrawn.

The only materials resting in contact with the vessel and adjacent partsof the patients body are the soft textile tape and the soft flexiblepieces of plastic tubing, so that trauma and the danger of possibledamage to delicate body parts are minimized. The applicator is so simpleand inexpensive that it may be considered disposable, but its simplicityalso adapts it for ready cleaning and sterilization if desired. At leastthe tape and plastic tubing would normally be discarded after use. Theterm tape is used herein to include flexible cord-like elements, whetherbraided, twisted, plied or monofilament. While the arrangement of a bentwire having both ends fixed in a handle is particularly convenient, apossible alternative could be a wire or the like, having a handle on oneend and a suitably shaped loop on the other; such a device could be madefrom a single piece of plastic material. The term loop" is intended toinclude a hook of suitable shape, i.e., one over which the tubing can bepassed without catching.

What is claimed is:

1. A vessel ligature or clamp applicator comprising an elongated wireelement terminating at one end in an integral loop, a piece of plastictubing shorter than said element and fitted thereon, said tubing beingslidable past said loop onto a piece of tape having both its ends passedthrough said loop, the plastic tubing being further slidable along saidtape and a handle fixed to the opposite end of said wire element.

2. A vessel ligature or clamp applicator according to claim 1 in whichthe elongated wire element is a wire doubled on itself adjacent itsmiddle, and in which the handle is affixed to both ends of said wire.

3. A vessel ligature or clamp applicator according to claim 2 in whichthe wire loop is curved to form an opening through which the tape endscan readily be passed.

4. A vessel ligature and applicator assembly comprising an elongatedwire element terminating at one end in an integral loop, a piece ofplastic tubing shorter than said element and fitted thereon, said tubingbeing slidable past said loop, a handle fixed to the opposite end ofsaid wire element, and a piece of tape having two ends adapted to bedoubled on itself around a vessel to be ligated, the end portions beingengaged in the loop and adapted to be drawn through the tubing byrelative sliding movement of the tubing and the wire element and to bereleased from the loop when the tubing is slid therefrom.

5. A vessel ligature and applicator assembly according to claim 4 inwhich the plastic is of a soft composition and is adapted, by slidingalong the double tape, to tighten the bight of the tape around thevessel with minimum danger of damage to the vessel.

1. A vessel ligature or clamp applicator comprising an elongated wire element terminating at one end in an integral loop, a piece of plastic tubing shorter than said element and fitted thereon, said tubing being slidable past said loop onto a piece of tape having both its ends passed through said loop, the plastic tubing being further slidable along said tape and a handle fixed to the opposite end of said wire element.
 2. A vessel ligature or clamp applicator according to claim 1 in which the elongated wire element is a wire doubled on itself adjacent its middle, and in which the handle is affixed to both ends of said wire.
 3. A vessel ligature or clamp applicator according to claim 2 in which the wire loop is curved to form an opening through which the tape ends can readily be passed.
 4. A vessel ligature and applicator assembly comprising an elongated wire element terminating at one end in an integral loop, a piece of plastic tubing shorter than said element and fitted thereon, said tubing being slidable past said loop, a handle fixed to the opposite end of said wire element, and a piece of tape having Two ends adapted to be doubled on itself around a vessel to be ligated, the end portions being engaged in the loop and adapted to be drawn through the tubing by relative sliding movement of the tubing and the wire element and to be released from the loop when the tubing is slid therefrom.
 5. A vessel ligature and applicator assembly according to claim 4 in which the plastic is of a soft composition and is adapted, by sliding along the double tape, to tighten the bight of the tape around the vessel with minimum danger of damage to the vessel. 